This week we continue our series on Borderline Personality Disorder (BPD).

BPD is a brain-based emotion regulation disorder that affects an estimated 18 million Americans. Usually appearing first in early adulthood, by the time BPD is accurately diagnosed, many close relationships may already be irreparably damaged or destroyed.

In our last post, I introduced you to one of the most powerful techniques loved ones can use to facilitate improved relationships with a BPD sufferer. The technique is called Validation, and in this post I will introduce the basics of how Validation works and how to use it.

Validation works by making approval of, appreciation for, and understanding of the BPD sufferer a priority over any other message that may be conveyed. Basically, validation is a technique that softens the delivery of a message without changing its content overly much.

Using Validation challenges the loved one of a BPD sufferer to find a way to stand in their shoes, understand what their world is like, and communicate from that place of empathy and understanding. In a sense, imagining that you have the same symptoms and imagining how communications might affect you in that case paves the way for Validation to have its positive effect.

Its usefulness in managing BPD aside, Validation is a powerful technique in its own right. Whether an individual suffers from BPD or not, Validation is still an important part of any trusted connection, and loved ones can draw from their own positive experiences of receiving Validation to use the technique with a BPD loved one. The difference between a non-BPD and a BPD individual’s experience of receiving Validation is one of magnitude of the need for it, rather than the necessity of receiving it.

One Validation exercise that can be extremely helpful is what Dr. Marsha Linehan, founder of Dialectical Behavioral Therapy (DBT) and creator of DBT tools such as Validation, calls the “Validation Sandwich”.

Understanding how the Validation Sandwich works can streamline communications between a BPD sufferer and his or her loved ones.

When employing the Validation Sandwich to express preferences or feedback that have the potential to provoke an extreme reaction in someone with BPD, DBT experts guide loved ones to place validating statements before and after the potentially distressing communication.

In this way, the individual with BPD hears and takes in that they are seen, heard, known, and supported right from the start, and as a result they become more willing and able to hear out difficult communications with less fear of abandonment or rejection.

DBT-trained experts guide loved ones to become more acutely aware of areas where the BPD individual is behaving in responsible, emotionally sound, and healthy ways, and to make validating those behaviors a priority in any communication, whether light or more serious. Validation is not meant to sugar-coat the acting out of the symptoms of BPD, but rather to reinforce the visible signs of recovery progress.

Validation lets the BPD sufferer know that their efforts are noticed and applauded, and that there is genuine care and affection for the person, even if there is less tolerance for the behaviors as they occur. In this way, slowly but surely, the balance shifts to create a more trusting, stable foundation for future communications to occur.

Another popular Validation technique is known by its acronym – GIVE. GIVE stands for Gentle, Interested, Validating, and Easy in manner. Practicing GIVE reigns in a loved one’s propensity towards fighting fire with fire (by reacting in kind to a BPD-based outburst) and instead teaches a more effective way of fighting fire – with cooling, calming water. With GIVE, attacks or outbursts are met with gentleness and an even demeanor, with empathy and understanding, with the ability to sift the wheat from the chaff in behavioral expression, and with an easefulness that comes from sincerely believing that BPD is a treatable disorder and that the BPD sufferer has what it takes to recover.

GIVE, like other Validation techniques, is very affirming and reassuring to the individual with BPD, and has an equal effect on loved ones when they see that Validation truly does open up new lines of communication in previously strained relationships.

If you or someone you care about is suffering from symptoms that appear to be related to Borderline Personality Disorder, don’t wait! Seek help right away as BPD can be life threatening. At Southlake Counseling, our staff has received extensive training from DBT Founder Dr. Linehan’s Behavioral Tech Institute. We have more than two decades of experience successfully treating BPD through Dialectical Behavioral Therapy. We also offer supportive DBT-based skills-building groups for family, loved ones, and friends of BPD sufferers. These groups instruct loved ones in DBT techniques such as Validation and much, much more. Learn more at www.southlakecounseling.com.

Whether our relationship with our own father was close or distant, the impact a father has in the life of a daughter is undeniable. And when we begin a family of our own, whether we share duties of child-rearing with a partner or shoulder the responsibility of both mother and father alone, our experience with our father goes with us. It serves us well to employ what Marianne Williamson, author of a “Return to Love,” terms “selective remembering” – “a conscious decision to focus on love and let the rest go.”

This week I resolve to: Celebrate what I learned from my own father, employing the timeless wisdom of “selective remembering” to pass along love and leave the rest behind.

Eating disorders are bio-psycho-social illnesses. They are also very treatable. With the right treatment, in appropriate doses, at appropriate times, and for an appropriate length of time, they are even curable.

But medical limitations, patient reluctance, or even media messages are not the primary deterrent to recovery.

The number one reason patients do not get better faster is a plain and simple deficit of information.

In my more than two decades of treating and supporting both eating disordered patients and their loved ones, I have learned a great deal about the type of information that is needed to effectively mobilize a family around a child who is suffering. This article addresses ten keylearnings that can take your family from frozen to fantastic in how you collectively band together to combat a child’s life threatening illness.

The first key learning is – do not blame yourself. And do not blame your child. It is nobody’s fault when the biologically-based illness that is an eating disorder arises, in the same way that it is nobody’s fault when a child develops leukemia or autism, or an adult woman develops endometriosis. What is needed and effective is not blame, but rather action in the form of appropriate professional care and informed family and community support.

The second key learning is – an eating disorder is a bio-psycho-social illness with genetic links. Eating disorders have their underpinnings in a biological brain imbalance that results in the affected individual processing the presence of nutrients differently than someone without that imbalance would. As the National Eating Disorders Association states, “biology loads the gun, and environment pulls the trigger.” In the thin-obsessed culture we live in today, there is a clear biological reason why not every exposed individual develops a diagnosable eating disorder. Not everyone is at risk, because not everyone carries the genetic linkages that predispose an individual to develop an eating disorder. Those who develop an eating disorder are life-threateningly ill and require prompt and comprehensive care.

The third key learning is – do not panic. Instead, learn all you can. Getting educated by reading high quality books and visiting nonprofit and medical websites that contain accurate information about eating disorders will help you and your family understand what you are dealing with, in the same way that a diagnosis of breast or prostate cancer might prompt the affected individual and their family to carefully review current treatments, options, success rates, and risks involved. In the case of an adolescent who is affected, the responsibility clearly rests with the parents to do the homework necessary to pick the best course of care. The more you are able to learn about what to expect, the timeline involved in recovery, what works better in which kinds of cases, and who in your area has expertise in treating eating disorders, the less energy you will waste in fear, indecision, self doubt, and frustration with the recovery process.

The fourth key learning is – get help. Do not attempt to self-diagnose or self-treat an ill child or loved one. Eating disorders are the most lethal of all psychiatric-based diseases. They are treatable and even curable – with appropriate professional care. For adolescents in particular, learn as much as you can about newer cutting edge protocols such as Family Based (Maudsley) Method (FBT) or Dialectical Behavioral Therapy (DBT), both of which have shown excellent results in improving symptoms and returning the affected individual to a healthy state.

The fifth key learning is – don’t forget about your own self-care needs. Supporting your child will take an incredible amount of time and energy. There will be times when you will feel hopeless, exhausted, frustrated, confused. To avoid burning out during each leg of the recovery process, remember that you can accept support and you deserve support . You are working as hard as your child, albeit from a different perspective, and you need to apply good self-care or you will not have the stamina you need to see the recovery process through to its successful conclusion. Seek out supportive groups online or in your area – for example, FEAST-ED.org is an excellent parent support site that offers parent-to-parent mentoring via an online forum called “Around the Dinner Table.”

The sixth key learning is – shame has no place in recovery from any illness, including an eatingdisorder. We have come a long way from the “don’t ask – don’t tell” generation our parents and grandparents labored under. We know so much more now about what causes psychiatric illness and how to help affected individuals and their loved ones navigate the recovery process. Whether it is cancer, loss, unemployment, divorce, or another personal tragedy, no one is a stranger to the need to recover from life’s unexpected challenges. With your acceptance and validation of your child’s illness, you strengthen your child and your entire family to own the challenge ahead as a learning process and a chance to grow stronger. Don’t let shame rob your child and your family of that energizing and motivating gift.

The seventh key learning is – remember that your child and your child’s illness are not one and the same. Your child is a unique, wonderful individual with endless promise and potential. Your child’s illness is something that he or she struggles with that requires appropriate treatment to overcome. They are two different things. It is important to start immediately to emotionally separate out who your child is from what your child is struggling with. Love the child, treat the disorder – they are not one and the same.

The eight key learning is –DO NOT WAIT. An eating disorder will not suddenly get better or go away if ignored. Pretending the disorder is not there may cause the child to hide the symptoms out of shame or fear, but disappearance of symptoms is cause for increased rather than decreased concern. Act immediately the moment you see the first sign of symptoms. Research has shown that the sooner an eating disorder is intervened upon, the faster and shorter the recovery period will be.

The ninth key learning is – make sure the treatment you choose is evidence-based. What this means is that, with the wealth of options available today, it is easy to get confused about what is the best choice for your child. Go with where the evidence is. Interview medical professionals and ask for success rates. Contact nonprofit and professional organizations and ask to read recent medical journal and research reports concerning treatment protocols you are interested in pursuing. Talk with other families about what worked for them. Ask medical professionals for references and call those references to find out what their experiences have been like. Most of all, seek a treatment protocol for your child that is well researched and shows consistent positive results. Treatment is expensive no matter what route you choose, so go for what works.

The tenth key learning is – never discount the transformative power of unconditional love. As the disease takes hold, you may find yourself thinking, “Is this my child?” The answer is “No.” The voice of the disorder at work within your child’s brain may create a different relational dynamic for awhile, as her relationship with food and fear changes and then changes again throughout each phase of the recovery process. Fear is a powerful agent, and may produce bouts of rebellion, resistance, even rage. But underneath any show of resistance, bravado, or anger is a frightened child who is doing her best to understand what is happening and figure out what to do about it. It is no different than the brain changes a bout of chemotherapy or radiation might cause – it is temporary, and reversible with application of proper nutrient levels that produce brain re-balancing with a corresponding return of emotional stability. Love your child, treat the disease, fight it together as a family.

At Southlake Counseling, we have more than two decades of expertise in treating adolescents and families affected by eating disorders. Our specializations include Family Based (Maudsley) Training (FBT) and Dialectical Behavioral Therapy (DBT). Our founder and staff received training directly from Dr. Nancy Zucker, the director of the Duke University Eating Disorders Program, which incorporates both FBT and DBT protocols in their highly successful family-based treatment program. Our clinical director has also received training directly from Dr. Locke and Dr. Le Grange, authors of Helping your Teenager Beat an Eating Disorder. At Southlake Counseling, we have seen firsthand how families that recover together grow closer and stronger together. We encourage you to reach out for help and experience the difference expert, compassionate professional care can make in your family’s life. Visit us today at www.southlakecounseling.com to learn more.

As we continue our exploration of the application of Family-Based Therapy for recovery from anorexia nervosa, it might be helpful if we first do a quick review.

In Part 1 of this series we discussed why parental involvement in a child or adolescent’s recovery process is so vital to recovery success. Children need their parents. Parents want and need to be involved. Beyond these simple relational facts, research results have proven that a parent’s active involvement in a child’s recovery process is often a major determinant of a successful outcome.

There are three main stages for implementing a Maudsley or Family-Based Therapy (FBT) approach. The first stage is weight restoration. This phase is nearly guaranteed to strike fear into the hearts of even the most stalwart parents. The basis of this fear and trepidation, accordingly to treating professionals and parents active in the FBT approach, is a simple misunderstanding. Maudsley Parents, another parent support and advocacy organization, explains that the confusion comes in when a parent sees food as different from medicine. FBT treating professionals are able to clear up much of the confusion and fear when they explain to the parents that food is medicine, and as such it is both medically-prescribed and absolutely necessary for the reversal of the anorexic adolescent’s malnourishment.

During the weight restoration phase, the treating team, which often and ideally includes a medical doctor, therapist, dietician, and psychiatrist, coaches the parents on the proper administration and dosages of “food as medicine.” With coaching and support, parents learn how to empathize with the pain, fear, and anger their adolescent may express, while continuing to insist that the child take in proper dosages of the necessary medicine. Family mealtimes and parental supervision of caloric and nutrient intake is a vital part of the success of this phase. Simultaneously, siblings are taught how to support the patient, and the treating team works to help the patient reintegrate with siblings and with the family unit. Parents who persist and learn the skills necessary to successfully navigate the weight restoration phase find that it is tremendously healing and nurturing for both the patient and for the family unit as a whole.

The next phase is one parents will look forward to during the entirety of phase one, because in phase two parents begin turning control of eating back over to the adolescent. The family unit’s ability to transition to this phase is dependent upon the patient’s continued weight gain, acquiescence to continual increases in food intake, and a positive change in the demeanor and dynamic of the family unit. Often at this phase, everyone from the patient to the parents to the siblings is feeling relief that the eating disorder symptoms are being effectively and consistently addressed, and this relief changes the family interactions for the better, reducing resistance and strengthening resolve. Parents can then begin to give the patient more control over food choice and eating. There is a trust bond that is mutually demonstrated and earned again with each meal as parents see that the adolescent is both willing and medically able to make their own sound and healthy food choices. The patient is also able to eat away from the parents to such an extent as they are able to demonstrate the same healthy choices with friends, peers, and other family members that they do in the home. While this phase can feel stop-and-start especially at first, the entire family is encouraged by the patient’s progress through dependence to interdependence to eventual independence in making healthy nutritional choices and practicing effective body care.

During phase three, the focus moves beyond the food to a re-establishment of a healthy adolescent identity. This is the most exciting phase when parents, siblings, and the patient begin to see the real fruits of persistence with the FBT approach. Here, the adolescent is able to maintain 95% of their ideal weight consistently. Signs of desire or intent to self-starve have abated. The patient has newfound ability to navigate mealtimes with relative ease whether in the home or while out with friends or family. Privileges around food come back into alignment with other privileges that signal a growth from child to adolescent into the teen and young adult years. Often there is a much increased closeness within the family unit and signs of the fear, anger, and resistance that characterized much of phase one and into phase two have vanished (also easing residual parent concerns that phase one and two supervision may somehow irreparably harm the parent-child relationship – research results show that for most families the exact opposite is the case). With weight restoration and stabilization and mealtime autonomy also comes a willingness and ability on the part of the patient to look at some of the underlying triggers and issues that may have contributed to the anorexia. In phase three, the patient can begin or resume work with a therapist and other treating professionals to further discuss healthy life coping skills, identity development, and pursuit of life dreams and goals.

Emergence from phase three shows a young, bright, promising future where the anorexia used to be. The entire family continues to exercise vigilance even amidst beaming smiles and a huge, long sigh of RELIEF.

At Southlake Counseling, we have more than twenty years’ experience with successfully treating eating disorders, disordered eating, body image, self esteem, recovery, health, and wellness concerns in children, adolescents, young and mature adults. Our caring, compassionate, professional and highly trained staff partner with you and your family to smoothly navigate all three phases of the Family-Based Therapy (FBT) process. Discover how rewarding and satisfying it can be to become an active participant in your child or adolescent’s health and wellness by contacting us at www.southlakecounseling.com

When I read the words “three steps to…” I usually think, “Oh, here we go. Someone is about to tell me that something very difficult is really very easy.”

Rest assured, that is not going to happen here. I am a licensed treating professional with more than two decades of experience treating eating disorders, but I am first and foremost a parent too, and I know that all individual or family-based positive change takes persistence, patience, effort, and time.

So what I am about to share with you is not easy at all – but it is very possible, and it is highly effective. In this two-part blog series on implementing Family-Based Therapy (also called the Maudsley Method) for recovery from anorexia nervosa, we will examine the reasons behind the newfound acceptance and popularity of a family-based approach to treatment, as well as the three steps every family will follow to implement family-based therapy in the home.

The role of the parent in eating disorders recovery has long been a controversial one. In the past, treating professionals have commonly regarded parents as, if not the main culprits, at the very least a large part of the problem. Parents have been cordoned off from the treating area, banned from the therapy room, locked out of the kitchen.

Today that thought process is changing. Efforts from concerned parents such as Laura Collins, the author of “Eating With Your Anorexic” and founder of the F.E.A.S.T. parent support and advocacy group, and treating professionals like Dr. James Lock, co-author of the “Treatment Method for Anorexia Nervosa: A Family-Based Approach,” have reassured parents that they do have a place in the treatment process – and a vital role that only a parent can fill.

Additionally, there is a growing body of scientifically-sound research that highlights the efficacy of involving the parent in the adolescent’s recovery. The message is clear – parents can learn, parents can help, parents are needed.

For parents of an anorexic child or adolescent, this is very, very good news!

For single parents who are concerned that the process won’t work without a parental team, there is even more good news. Recent research has shown that the FBT approach can work equally well with a single parent head of household. The main determinant of success is not dual parenting but rather parent education, commitment, and involvement in the process.

Stay tuned next week for Part 2 when we examine the three phases of FBT, what a parent can expect during each phase, and a big picture look at a typical outcome for families who adopt the FBT approach.

At Southlake Counseling, we have more than twenty years’ experience with successfully treating eating disorders, disordered eating, body image, self esteem, recovery, health, and wellness concerns in children, adolescents, young and mature adults. Our caring, compassionate, professional and highly trained staff partners with you and your family to smoothly navigate all three phases of the Family-Based Therapy (FBT) process. Discover how rewarding and satisfying it can be to become an active participant in your child or adolescent’s health and wellness by contacting us at www.southlakecounseling.com